Sr Specialist, Member Engagement; Member Analysis Remote

OH, United States

Molina of Ohio is hiring for a Senior Specialist, Member Engagement, who will be handling the analysis and review of our members Value Added Benefits. This role is remote, however applicants must reside in Ohio.

This role is responsible for continuous quality improvements regarding member engagement and member retention. You will represent member perspective in areas involving member impact and engagement. Oversees, tracks, and reports on value-added benefits for Medicaid and MyCare Ohio.

Ideal candidates will demonstrate:

• Critical Thinking & Problem-Solving: Ability to think beyond the surface, ask thoughtful questions, identify root causes, and develop creative, strategic solutions.
• Comfort with Ambiguity: Ability to navigate uncertainty, work independently with limited direction, and adapt as priorities and information evolve.
• Initiative & Ownership: A self-starter who takes initiative, digs into challenges, follows through on commitments, and proactively seeks answers.
• Data Analysis & Storytelling: Demonstrated experience reviewing, analyzing, and interpreting data and complex datasets. Must be able to digest large amounts of information, identify trends, patterns, and potential gaps, and connect the dots to tell a clear, meaningful story. Ability to translate data into actionable insights, explain the "why" behind the numbers, and communicate findings that support strategic business decisions.
• Analytical
  
  Skills:
  
  Hands-on experience reviewing dashboards, evaluating performance metrics, and combining quantitative data with qualitative feedback to identify opportunities, uncover root causes, and recommend solutions.
• Advanced Excel Proficiency: Strong Excel skills are essential, including the ability to organize, analyze, and interpret complex data.
• Strategic & Creative Thinking: Ability to connect the dots, challenge assumptions, ask the right questions, and identify opportunities for improvement.
• Communication &
  
  Collaboration:
  
  Strong communication skills with the confidence and curiosity to ask questions, seek clarification, and engage stakeholders to drive results.

Smartsheet

Experience:

Preferred but not required

• Provides senior level support for member engagement and member retention activities. Represents members in areas involving member impact and engagement including: appeals and grievances and member issue research and resolution. Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member relationships.
  
  Recommends and implements programs to support member needs, and develops/maintains member materials.
• Provides direct telephonic assistance to members and/or member family members seeking to resolve complex issues or complaints; seeks to engage and retain new and existing members.
• Ensures enrollee's rights are upheld and helps enrollees understand their rights and benefits in working through the system.
• Assists members in the complaint and appeal process internally and at the state level; determines the nature of the member's needs or problem; informs members of their rights in the complaints and appeals process; advises/refers as appropriate for investigation and resolution, and monitors outcomes
• Serves as an advocate in collaboration with providers, regulatory agencies, outside agencies, colleagues and other functional departments as appropriate.
• Educates members on covered services available to them, including preventive services.
• Provides support to enrollees and providers in provision of plan benefits.
• Educates members on covered services available, including preventive services.
• Provides information, guidance and assistance over the phone or in person to members with disabilities who call for help related to plan participation; analyzes internal system functions that affect enrollee access to medical care and quality of care.
• Investigates and resolves access and cultural sensitivity issues identified by the enrollee, care management staff, the state, providers, advocate organizations, and subcontractors.
• Monitors all formal and informal grievances in collaboration with the appeals and grievances team; identifies trends or problem areas of member access and care delivery.
• Provides timely written responses to member inquiries; prepares…